Voice For Liberty

Tag: Government health care

  • Medicaid expansion survey in Kansas

    Medicaid expansion survey in Kansas

    Should Kansans accept the results of a public opinion poll when little is known about it?

    Recently American Cancer Society Cancer Action Network released results of a poll regarding Medicaid expansion in Kansas. What ACS CAN wants us to know is that 82 percent of Kansans favor expansion.

    But before we accept these results, we need to know that ACS CAN will not release the full results of the survey, as other organizations have done.

    In particular, last year Kansas Hospital Association conducted a poll on the topic of Medicaid expansion, and it released the complete poll and results.1

    This year Kansas Center for Economic Growth conducted a poll. It released the full results.2 From this release, we learned that one of the questions was so vague as to be open to many different interpretations.3

    Kansas Policy Institute conducts many polls and releases the full results.4

    Sample results from the poll. Click for the full chart.
    ACS CAN produced a short press release.5 Upon request, I received the text of one question and a chart of results.6

    But ACS CAN, despite multiple requests to several contacts, will not release the full results of the poll, as other public policy advocacy groups have done.

    It would be unfair to conclude that ACS CAN has something to hide, or that the poll was constructed in a way to be misleading. Conversely, it is not wise to give much weight to this poll when we know so little about it.

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    Notes

    1. Kansas Hospital Association. Public Opinion Poll: Medicaid Expansion and Access to Health Care in Kansas. Available at http://www.kha-net.org/communications/mediareleases/public-opinion-poll-medicaid-expansion-and-access-to-health-care-in-kansas_102768.aspx. ↩
    2. Kansas Center for Economic Growth. Results of Kansas statewide poll. Available at http://realprosperityks.com/wp-content/uploads/2017/03/TSPolling_KCEG_KansasStatewide_PublicReleasePacket_2017.03.30-final-1.pdf. ↩
    3. Weeks, Bob. Kansans are concerned about the level of state spending on schools. A public opinion poll asks whether Kansans are concerned about school spending, but leaves us wondering why they are concerned. Available at https://wichitaliberty.org/kansas-government/kansans-concerned-level-state-spending-schools/. ↩
    4. See, for example Kansans say no to more taxes at https://wichitaliberty.org/kansas-government/kansans-say-no-taxes/, Poll: Wichitans don’t want sales tax increase at https://wichitaliberty.org/wichita-government/poll-wichitans-dont-want-sales-tax-increase/, and New survey: Kansans remain misinformed regarding k-12 finance at https://kansaspolicy.org/new-survey-kansans-remain-misinformed-regarding-k-12-finance/. ↩
    5. American Cancer Society Cancer Action Network. Poll: Kansas Voters Overwhelmingly Support Medicaid Expansion. Available at https://www.acscan.org/releases/poll-kansas-voters-overwhelmingly-support-medicaid-expansion. ↩
    6. “Uninsured Kansans earning less than sixteen thousand dollars a year do not have access to any affordable healthcare coverage options. Kansas lawmakers are considering taking action that would provide these low-income residents access to coverage that would include primary care, preventive screenings, diagnostic testing, and cancer treatment services through the state’s KanCare program. The federal government would cover most of the cost to cover these state residents. Do you favor or oppose Kansas accepting the federal funds to increase access to healthcare coverage for thousands of hardworking Kansans through the state’s KanCare program?” Results at https://wichitaliberty.org/wp-content/uploads/2017/05/ACS-Kansas-Medicaid-poll-2017-exp-poll.pdf. ↩
  • WichitaLiberty.TV: Health care in Kansas and taxes in Sedgwick County

    WichitaLiberty.TV: Health care in Kansas and taxes in Sedgwick County

    In this episode of WichitaLiberty.TV: Bob Weeks and Karl Peterjohn discuss health care in Kansas and taxes in Sedgwick County. View below, or click here to view at YouTube. Episode 146, broadcast April 9, 2017.

    Shownotes

  • Kansas House voting on Medicaid expansion

    Kansas House voting on Medicaid expansion

    Here’s a table of the three votes taken in the Kansas House of Representatives in February and April on HB 2044, titled “Establishing the KanCare bridge to a healthy Kansas program and providing medicaid reimbursement for clubhouse rehabilitation services.” Medicaid expansion, in other words. This expansion is a key part of Obamacare, but not all states have not adopted the plan.

    Vote 3 on April 3 was to override the governor’s veto. 84 votes are required for a successful override.

    If you’re interested in contacting your legislators on this issue, click on House Roster and Senate Roster.

    To find the district numbers you live in, use Locate Your Polling Place, which is part of Vote Kansas.

  • Kansas House voting on Medicaid expansion

    There has been another vote on this bill, and the table has been updated. Click here.

    Here’s a table of the two votes taken in the Kansas House of Representatives in February on HB 2044, titled “Establishing the KanCare bridge to a healthy Kansas program and providing medicaid reimbursement for clubhouse rehabilitation services.” Medicaid expansion, in other words. This expansion is a key part of Obamacare, but not all states have not adopted the plan.

    If you’re interested in contacting your legislators on this issue, click on House Roster and Senate Roster.

    To find the district numbers you live in, use Locate Your Polling Place, which is part of Vote Kansas.

  • Kansas Senate voting on Medicaid expansion

    Here’s a table of the two votes taken in the Kansas Senate this week on HB 2044, titled “Establishing the KanCare bridge to a healthy Kansas program and providing medicaid reimbursement for clubhouse rehabilitation services.” Medicaid expansion, in other words. This expansion is a key part of Obamacare, but not all states have not adopted the plan.

    Reporting on this issue from The Sentinel is at Senate Advances Medicaid Expansion Proposal.

    If you’re interested in contacting your legislators on this issue, click on House Roster and Senate Roster.

    To find the district numbers you live in, use Locate Your Polling Place, which is part of Vote Kansas.

  • Expanding Medicaid in Kansas

    Expanding Medicaid in Kansas would be costly, undoubtedly more costly than estimated, has an uncertain future, and doesn’t provide very good results for those it covers.

    Providing testimony to the Kansas House Committee on Health and Social Services, Michael Tanner advised legislators, “Medicaid expansion, however, is a risky gamble, that is almost certain to cost more than you are currently budgeting, while providing surprisingly little to the poor in terms of improved access to health care.”

    Tanner is Senior Fellow at Cato Institute. The bill in question is HB 2064, titled “Establishing the KanCare bridge to a healthy Kansas program.” It would expand Medicaid eligibility to more people in Kansas. These quoted remarks are from Tanner’s written testimony, which may be read at Should Kansas Expand Its Medicaid Coverage.

    As to the cost of Medicaid expansion, Tanner wrote: “Second, while such estimates are concerning enough in themselves, and would almost certainly require a substantial tax hike to finance, there is ample reason to believe that they understate the actual cost. For example, actual enrollments following expansion have exceeded estimates in every state that has expanded Medicaid under the ACA, in most cases by double digits and in some cases by more than 100 percent. In neighboring Colorado, the maximum projected enrollment was 187,000 and as of October of last year enrollment had exceeded 446,000. … In addition, the per enrollee cost has risen faster than predicted.”

    Then, there’s the woodwork effect, which costs are covered only at the regular Medicaid reimbursement rate, not the 94 percent citizens might be tempted to believe: “Third, while it may be tempting to focus on the 94 percent FMAP [Federal Medical Assistance Percentage] for newly eligible adults, you should keep in mind that many of those who enroll under expansion will not fall into this category. Rather, they will be previously eligible individuals or families that are lured into the system through the publicity and outreach efforts surrounding expansion. The Robert Wood Johnson Foundation and the Urban Institute have dubbed this the ‘woodwork effect.’ Woodwork enrollees are not eligible for the enhanced FMAP. Instead, Kansas will have to pay 43.79 percent. In states that have expanded Medicaid under ACA, as much as half or more of those who signed up have fallen into this woodwork category.”

    Tanner also noted the uncertainty over the future of the Affordable Care Act, or Obamacare, under the Trump Administration, warning legislators, “You may well be locking yourselves into future spending based on hopes for federal dollars that may never materialize.”

    He also noted the studies that have found that being on Medicaid does not result in very good health outcomes, most notable in the Oregon study.

  • Sedgwick County Health Department: Services provided

    Sedgwick County Health Department: Services provided

    Sedgwick County government trimmed spending on health. What has been the result so far?

    During last year’s Sedgwick County budget hearings, there were warnings that trimming spending on health would decimate the health department’s ability to provide services. But after six months, that hasn’t been the case.

    Sedgwick County Health Department services provided. Click for larger.
    Sedgwick County Health Department services provided. Click for larger.

    The nearby table shows measures of services provided for the first six months of this year compared to the same period the year before. The source of this data is the Sedgwick County Health Department, with my added column calculating the percent change. For most categories of service, the amount provided has risen or fallen slightly. The exception is WIC, the Women, Infants, and Children program. Participation in this program has fallen in Sedgwick County every year since peaking in 2010, mirroring the national trend.1

    Average Monthly WIC Participation per 1,000 population, Sedgwick County

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    Notes

    1. KansasHealthMatters.org. Average Monthly WIC Participation per 1,000 population. Available here. ↩
  • Inspector General evaluates Obamacare website

    Inspector General evaluates Obamacare website

    The HHS Inspector General has released an evaluation of the Obamacare website HealthCare.gov, shedding light on the performance of former Kansas Governor Kathleen Sebelius.

    The Office of Inspector General for the Department of Health and Human Services has released a report titled HealthCare.gov: Case Study of CMS Management of the Federal Marketplace. An excerpt from the executive summary holds the main points:

    What We Found

    The development of HealthCare.gov faced a high risk of failure, given the technical complexity required, the fixed deadline, and a high degree of uncertainty about mission, scope, and funding. Still, we found that HHS and CMS made many missteps throughout development and implementation that led to the poor launch. Most critical was the absence of clear leadership, which caused delays in decisionmaking, lack of clarity in project tasks, and the inability of CMS to recognize the magnitude of problems as the project deteriorated. Additional HHS and CMS missteps included devoting too much time to developing policy, which left too little time for developing the website; making poor technical decisions; and failing to properly manage its key website development contract. CMS’s organizational structure and culture also hampered progress, including poor coordination between policy and technical work, resistance to communicating and heeding warnings of “bad news,” and reluctance to alter plans in the face of problems. CMS continued on a failing path to developing HealthCare.gov despite signs of trouble, making rushed corrections shortly before the launch that proved insufficient. These structural, cultural, and tactical deficiencies were particularly problematic for HealthCare.gov given the significant challenges of implementing a new program involving multiple stakeholders and a large technology build.

    The problems are not solved. Challenges remain, the report says, including “contract oversight, the accuracy of payments and eligibility determinations, and information security controls.”

    Who is responsible for the debacle? In a hearing before Congress, HHS Secretary and former Kansas Governor Kathleen Sebelius said “hold me accountable.” View a video clip below, or click here to view at C-SPAN.

  • Cost of restoring quality of life spending cuts in Sedgwick County: 43 deaths

    Cost of restoring quality of life spending cuts in Sedgwick County: 43 deaths

    An analysis of public health spending in Sedgwick County illuminates the consequences of public spending decisions. In particular, those calling for more spending on zoos and arts must consider the lives that could be saved by diverting this spending to public health, according to analysis from Kansas Health Institute.

    Kansas Health Institute is concerned about proposed reductions in public health spending in Sedgwick County. Sunday it released a fact sheet titled Decreases in Public Health Spending Associated with More Deaths from Preventable Causes, subtitled “Analysis of how proposed public health funding reductions in Sedgwick County could lead to more preventable deaths over time.”

    Kansas Health Institute infographic
    Kansas Health Institute infographic
    KHI’s analysis is based on the paper “Evidence Links Increases In Public Health Spending To Declines In Preventable Deaths,” Glen P. Mays and Sharla A. Smith, Health Affairs, 30, no.8 (2011):1585-1593, available here. Excerpts from the paper are below. KHI summarizes the findings of the paper as: “In short, the research showed that increased spending by local public health agencies over the thirteen-year period studied was linked to statistically significant declines in deaths from some preventable causes such as infant mortality, heart disease, diabetes and cancer.”

    KHI developed a model based on the paper’s findings to conclude that the proposed reductions in spending on public health in Sedgwick County would result in the deaths show in the nearby table from their fact sheet. The total of these numbers is an additional 65 deaths per year.

    Perhaps in response to these findings, two Sedgwick County Commissioners have proposed eliminating the proposed cuts. To help understand the effects of this spending, I duplicated the analysis performed by KHI. I took the proposed increases in spending (or reductions in cuts) and subtracted the spending for public health, leaving $1,019,499 in spending that loosely qualifies as “quality of life” spending. It’s for things like the zoo, Exploration Place, economic development, and the like.

    Sedgwick County spending analysis based on Kansas Health Institute model. Click for larger version.
    Sedgwick County spending analysis based on Kansas Health Institute model. Click for larger version.
    As can be seen in the nearby illustration, if this quality of life spending was instead spent on public health, we could save 43 lives per year. Based on the methodology used by KHI, this is the human cost of restoring only the proposed cuts to quality of life spending in Sedgwick County. If we were to use the totality of quality of life spending, or even just a subset like the $5.3 million spent on an elephant exhibit, the cost in human lives is large. This, of course, assumes that the KHI methodology is valid and reliable.

    In its summary, the KHI report states: “Budget decisions have real consequences.” Those supporting spending on quality of life issues instead of public health have some explaining to do.

    Excerpts from Mays et al.

    “On balance, there is very little empirical evidence about the extent to which differences in public health spending levels contribute to differences in population health. Several cross-national studies have found weak and conflicting associations between spending and health outcomes at a national level.”

    In a section titled “Limitations” the authors note “Several limitations of this analysis are worthy of emphasis. Although we used strong statistical controls to address possible sources of bias, it remains possible that factors distinct from, but closely correlated with, public health spending may explain some of the observed associations between spending and mortality.”

    Also, “Local public health activities may have important and perhaps more immediate effects on these other indicators of health … this analysis may underestimate the health consequences of changes in local public health spending.”

    In conclusion, the authors write: “Our analysis supports the contention that spending on local public health activities is a wise health investment. Increasing such investments in communities with historically low levels of spending may provide an effective way of reducing geographic disparities in population health. However, more money by itself is unlikely to generate significant and sustainable health gains.”